Article and readings
Catalano’s ethical decision-making algorithm (as cited in Blais and Hayes, 2016, p.64) or the Clinical Application of Bioethical Decision-Making Model (as cited in Blais and Hayes, 2016, p. 65-66).
Read the case study below and answers questions.
Case Study: End of Life
Doreen Smalls, is an 82-year-old female admitted to the intensive care unit with a watershed stroke. She has been artificially ventilated for three days, has received all the appropriate rescue medications and there are no signs of improvement. The physician caring for Ms. Smalls meets with the family and discusses the options related to end of life. Ms. Smalls does not have an advanced directive and her family are arguing about what they believe should be done.
Using the Bioethical Decision Model from the readings, how would you assist in resolving this dilemma?
Ensure that you include all the components that enter into the decision-making process.
In the complex and emotionally charged context of end-of-life decisions, healthcare professionals often find themselves facing ethical dilemmas that require careful consideration and resolution. In the case study of Doreen Smalls, an 82-year-old female with a devastating watershed stroke, the absence of an advanced directive and a divided family make the decision-making process even more challenging. To guide us through this ethical dilemma, we will employ Catalano’s Clinical Application of Bioethical Decision-Making Model, as cited in Blais and Hayes (2016, p. 65-66).
Catalano’s Bioethical Decision-Making Model is a structured approach to navigating complex ethical situations in healthcare. It comprises several key components that must be considered when addressing such dilemmas. Let’s explore how this model can be applied to resolve the dilemma in Doreen Smalls’ case.
The first step in Catalano’s model involves identifying the ethical problem. In this case, the issue is whether to continue artificial ventilation for Ms. Smalls, who has shown no signs of improvement after three days of intensive care. The conflict arises due to the absence of an advanced directive and the family’s differing opinions.
Next, it’s essential to clarify the values of all stakeholders involved. This includes the medical team, the patient (if able to communicate), and the family members. Understanding their values and beliefs will help establish common ground and promote open communication.
Informed decision-making relies on gathering all relevant medical information. In Ms. Smalls’ case, it’s vital to provide the family with a clear and comprehensive explanation of her condition, prognosis, and potential outcomes with and without continued ventilation.
The model encourages the exploration of available options. These may include continuing ventilation, withdrawing ventilation and transitioning to palliative care, or seeking a second medical opinion. Each option should be discussed thoroughly with the family, considering the potential benefits, risks, and burdens.
Informed by the values and information gathered, the medical team and the family must engage in deliberation and shared decision-making. This process should be guided by principles such as beneficence (doing what is best for the patient), autonomy (respecting patient wishes), non-maleficence (avoiding harm), and justice (fairness in resource allocation).
Once a decision is reached, it must be implemented with sensitivity and compassion. If the family chooses to withdraw ventilation, end-of-life care should be administered to ensure Ms. Smalls’ comfort and dignity during her final moments.
Finally, the decision and its consequences should be continually evaluated. Regular communication with the family is essential to ensure they remain well-informed and supported throughout the process. This step also involves reassessing the patient’s condition and the chosen course of action.
Resolving the end-of-life dilemma in Doreen Smalls’ case necessitates a systematic approach that considers the complexities of medical ethics and human values. By applying Catalano’s Clinical Application of Bioethical Decision-Making Model, healthcare professionals can guide the family through the decision-making process with empathy and transparency. Ultimately, the goal is to reach a decision that respects the patient’s best interests, aligns with her values (if known), and upholds the principles of medical ethics.
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